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Obituaries
About Us
Location
Services
Merchandise
Pricing
Forms
- Forms
- Vital Statistics Form
Pre-Plan
Veterans
Resources

Vital Statistics Form

Vital Statistics Information

Full Legal Name of Deceased

Sex

MaleFemale

If Female, Maiden Name

Date of Birth

City & State or City & Foreign Country of Birth

Social Security Number

Race

Was Decedent in US Armed Forces?

YesNo

Was Decedent ever a Police Officer in Texas

YesNo

Education

8th Grade or Less

9th-12th, No Degree

High School Graduate or GED

Some College, No Degree

Associate

Bachelor's

Master's

Doctorate

Marital Status

MarriedNever MarriedWidowedDivorced

If Married, Surviving Spouse's Full Name (include maiden name, if wife)

Decedent's Usual Occupation During Most of Life

Kind of Business or Industry

Decedent's Residence Street Address:

Street

City

State/Province

ZIP/Postcode

Is Residence Inside City Limits

YesNo

Decedent's Father's Name

Decedent's Mother's Full Name (including maiden name)

Name & Relationship of Informant

Mailing Address of Informant:

Street

City

State/Province

ZIP/Postcode

Phone Number of Informant

Number of Certified Copies of Death Certificates:

Anti-Spam Security Question

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Visit www.prepaidfunerals.texas.gov for information relating to the purchase of pre-need funeral contracts including descriptions of the trust and insurance funding options available under state law.